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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your pharmacy name and address in the designated fields at the top of the form.
- Fill in your contact information, including phone and fax numbers, ensuring accuracy for future correspondence.
- Select the ownership type of your pharmacy by checking the appropriate box. If 'Other', please specify.
- Complete sections regarding licensing details, including license numbers and expiration dates as required.
- List all pharmacy staff involved in compounding duties, ensuring to include their RPH or APH numbers and expiration dates.
- Proceed through each section of the self-assessment, marking 'Yes', 'No', or 'N/A' as applicable. If you select 'No', provide corrective action plans where indicated.
- Review all entries for completeness and accuracy before saving or printing your completed assessment for records.
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